Online Forms

 Dr. Clemons offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Intake Form

Download & Print Form


Acknowledgement of Receipt of Notice of Privacy Practices

Download & Print Form


Consent To Treat

Download & Print Form


Patient Demographic Form

Download & Print Form


Download the Free Adobe Reader®

We look forward to hearing from you!

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Please do not submit any Protected Health Information (PHI).

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